Money, Personal Preferences Push States on Long-Term Care: Staying in Your Home

Facing a wave of aging baby boomers, many states are trying to make it easier for frail seniors to stay in their homes — as many prefer — instead of moving into more costly nursing homes.

States have a huge stake in where aging seniors and disabled people end up getting long-term care because many of them won’t be able to afford to pay for their care and will have to rely on Medicaid, the health care program for the poor and disabled. Each state has its own Medicaid program, funded jointly by the state and the federal government.

Some states have been ahead of the pack in dealing with long-term care issues. In Minnesota, for example, nursing home beds have been cut more than a third as the state focuses on its home and community-based care system. In Hawaii, the state set up a program offering frail older adults in-home services at no charge.

More than a dozen states now allow residents whose income exceeds the threshold for Medicaid eligibility and who want to get care in their homes to set up a Miller Trust, a separate bank account for medical or other approved expenses. The states exclude that money when determining whether residents are needy enough to qualify for Medicaid in-home services, which can allow people to stay in their homes.

Nebraska passed a measure last year to set up three resource centers that will provide long-term care information and access to services that can make it possible for people to stay in their homes and communities.

Some states, such as Vermont, run a program that compensates caregivers — often family and friends — for their time taking care of Medicaid-eligible seniors who choose to live in their own homes, but need assistance. This eases the burden on caregivers and makes it more likely they’ll be able to continue providing services.